经皮冠脉介入术后对比剂肾病的危险因素及血清可溶性Klotho蛋白的诊断价值

Risk factors of contrast nephropathy after percutaneous coronary intervention and the diagnostic value of serum soluble Klotho protein

目的分析经皮冠状动脉介入(PCI)术后发生对比剂肾病(CIN)的危险因素,并分析血清可溶性Klotho蛋白对CIN的诊断价值。方法回顾性分析2017年5月—2019年6月143例在苏州中西医结合医院接受PCI手术患者的临床资料。根据术后是否发生CIN将143例患者分为CIN组(27例)和非CIN组(116例)。采用logistic回归分析发生CIN的危险因素,采用受试者工作曲线(ROC)评估Klotho蛋白诊断CIN的价值。结果PCI术后CIN发生率为18.89%。CIN组合并糖尿病比例、收缩压、空腹血糖(FBG)、血肌酐(Scr)、尿酸(UA)、胱抑素C(CysC)、超敏C反应蛋白(CRP)、同型半胱氨酸(Hcy)高于非CIN组(P<0.05),而eGFR、Klotho蛋白水平低于非CIN组(P<0.05)。logistic回归分析显示,Scr(OR=1.017)、eGFR(OR=3.443)及Klotho蛋白(OR=2.855)是发生CIN的危险因素(P<0.05)。Pearson分析显示,Klotho蛋白与Scr呈负相关(r=-0.32,P<0.05),与估算的肾小球滤过率(eGFR)呈正相关(r=0.45,P<0.05)。Klotho蛋白诊断CIN的曲线下面积为0.823,灵敏度为87.2%,特异度为74.5%,约登指数为0.617。结论Scr、eGFR及Klotho蛋白是发生CIN的危险因素,其中Klotho蛋白对CIN具有较好的诊断价值。

Objective To analyze the risk factors of contrast induced nephropathy(CIN)after percutaneous coronary intervention(PCI),and to analyze the diagnostic value of serum soluble Klotho protein for CIN.Methods A retrospective analysis of the clinical data of 143 patients undergoing PCI surgery at Suzhou Integrated Traditional Chinese and Western Medicine Hospital from May 2017 to June 2019.According to whether CIN occurred after operation,143 patients were divided into CIN group(27 cases)and non-CIN group(116 cases).Logistic regression was used to analyze the risk factors for CIN,and the receiver operating curve(ROC)was used to evaluate the value of Klotho protein in the diagnosis of CIN.Results The incidence of CIN after PCI was 18.89%.CIN combination and diabetes ratio,systolic blood pressure,fasting blood glucose(FBG),serum creatinine(Scr),uric acid(UA),cystatin C(CysC),high sensitivity C-reactive protein(CRP),homocysteine(Hcy)were higher than the non-CIN group(P<0.05).The estimated glomerular tiltration rate(eGFR)and Klotho protein levels were lower than those in the non-CIN group(P<0.05).Logistic regression analysis showed that Scr(OR=1.017),eGFR(OR=3.443)and Klotho protein(OR=2.855)were risk factors for CIN(P<0.05).Pearson analysis showed that Klotho protein was negatively correlated with Scr(r=-0.32,P<0.05),and positively correlated with eGFR(r=0.45,P<0.05).The area under the curve of Klotho protein in the diagnosis of CIN was 0.823,the sensitivity was 87.2%,the specificity was 74.5%,and the Youden index was 0.617.Conclusion Scr,eGFR and Klotho protein are the risk factors for CIN,and Klotho protein has good diagnostic value for CIN.